Miscellaneous Pain Histories

Had several notable histories from patients in pain lately.

One patient with chronic back pain hobbled into a room and said “I better not be waiting here 8 hours like I did last time.”
We looked through her old chart out of curiosity to find out what caused the extended eight hour wait on her previous visit. The longest that she had waited in her prior seven visits before getting her shot of Dilaudid so she could go home and sleep was 2 hours and 15 minutes.
Of course, making comments like that to the staff has no effect on anyone’s passive-aggressive behavior. Really, it doesn’t.

Another patient with chronic back pain had an acute exacerbation and needed pain medication. When he took off his coat, he was wearing a T-shirt that had a logo on the back. At the top was “Stoner Steve’s.” Underneath was a big circle with a line through it. Inside the circle was written “Motrin, Klonopin, Ultram”. The line through the circle was a marijuana joint. Why in this world Stoner Steve decided to advertise his aversion to these three specific medications is beyond me.
Of course, wearing a shirt like that to a hospital emergency department and asking for pain medication has no effect on the doctor’s tendency to prescribe you Motrin, Klonopin, and Ultram. Really, it doesn’t.

Finally, there was a patient with a chronic toothache. He tried taking some Vicodin that he had in a cabinet, but it didn’t taste right and, more importantly, it didn’t work. Then he looked at the bottle and it was a year out of date. And he stored the bottle above his refrigerator, so the heat probably degraded the medication even more. So he dumped the rest of the bottle into the toilet and flushed them. He needs another prescription to replace those pills. And he didn’t bring the bottle, either. He threw that out.
First of all, medications don’t all turn into arsenic the millisecond after their expiration date. Few medications lose much potency after expiration, either. See WSJ article here (full text here).
More importantly, most states have a database that tracks when patients fill prescriptions for controlled substances. Presenting with a history like this doesn’t affect the tendency for a doctor to look up your name on the state database. Really, it doesn’t.
It does make things a little uncomfortable when a patient hasn’t filled an opiate prescription for more than a year and I show them a printout that they have filled five opiate prescriptions from different doctors in the past month.
What? Wait. Where are you going? Why are you leaving? I was going to write you a prescription for Motrin … or Klonopin.

This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

13 Responses to “Miscellaneous Pain Histories”

Thank you for all you do for those who need you. Your skills, training and compassion are matched with other first line responders, the brave men and women who literally lay their lives on the line day in and day out to keep our communities and neighborhoods safe and habitable.

I was quite surprised to find out that there was a database for other things medically related, not just the rx’s. I get the RX stuff as a necessity, but why is there a database for other info? Isn’t that violating privacy?

And as luck would have it, all of those guys will be the recipient of the Press Ganey survey. Not the grateful and appreciative family whose little boy you sewed back together after a dog attack. Sigh.

The last sentences of your blog reminded me of the scene from “Young Frankenstein” where the character played by Gene Hackman is calling out to the monster,”Wait, come back, I was going to make espresso”.

We have a database in Indiana that tracks all scheduled narcotics, my pain doctor helped design it and there is a new sign in all the ER rooms that state, if you are here for chronic pain you will be given non-narcotic meds only, you will not be given a prescription refill for narcotics or sedatives and your prescription history will be reviewed for the past 24 months. In the event that your treatment requires either narcotics or sedatives you will only be given them if you have a driver over the age of 18. That’s the jist of it anyway. I don’t go to the ER for my pain management, when I do go to the ER I’m admitted 95% of the time.

Okay I have a question for all you ED docs out there. This probably belongs on open mic weekends, but here goes anyway: what’s this survey you keep talking about? I have been to the ED three times this year (for severe allergic reactions, I seem to be allergic to everything) but I have never been asked to take any surveys while there. What is it? Thanks!